MEDI-CAL Members FAQs

  • How can I join the Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018)?

    Enrollment for Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) is processed by Health Care Options (HCO). You may contact them directly at 1-800-430-4263. HCO will mail you an enrollment packet that you will need to fill out and mail back to them. Once HCO receives your packet, it takes 15 to 45 days for you to become a member of Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018).

  • How can I obtain Specialty Services?

    If you need care from a specialist, your PCP doctor must approve these services before you receive them.

  • What should I do if I need Behavioral Services?

    Behavioral Services are not a covered benefit under the plan. If you need to obtain these services you may contact the toll-free numbers provided below.

    Medi-Cal members who require behavioral health services can contact the Department of Mental Health's Local 24 hour crisis line at:

    Los Angeles: 1-800-854-7771
    San Diego: 1-800-479-3339
    The Department of Mental Health also has a suicide prevention hotline at 1-800-273-8255
  • How can I get a new ID card, update my address, change my PCP or contact Member Services?

    Contact Member Services. Our Member Service Department is available to assist you. Call us at 1-800-605-2556, Monday through Friday, 8:00 a.m. to 6:00 p.m. Our staff is comprised of Member Representatives that speak English, Spanish, Chinese, Armenian and Russian, and can answer any questions that you may have in regards to your health plan benefits. If you speak another language Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) Health Plan can also assist you through the use of one of our translators.

    Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) ID Card. Call Member Services and they will issue you a new one. You should receive your new card within 7-10 business days.

    PCP Change. As a member of Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018), we want you to be comfortable with your assigned primary care doctor. Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) has a large group of doctors for you to choose from. You may change your doctor by calling our Member Services Department at 1-800-605-2556. A change of doctor can be requested at any time, but it can take up to 30 days for the change to take effect.

    Update Address. Call Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018). We will update your address and instruct you to contact your eligibility worker at the DPSS toll-free number, 1-866-613-3777.

  • I'm a new Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) member. When can I expect to receive my Welcome Packet?

    When you become a member of Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018), you will receive a "Welcome Packet" within the first 7 days of eligibility. The "Welcome Packet" will include a welcome letter, Provider Directory, Evidence of Coverage, and your Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) ID card.

  • I understand Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) offers transportation services, How can I arrange for a ride?

    You are covered for transportation services to all routine, specialty, laboratory, and dental medical appointments. Some restrictions may apply. Please call Care 1st Transportation Department at 1-87RIDEC1ST (1-877-433-2178) from 8:00am – 5:00pm., Monday through Friday, at least 24 hours in advance.

  • What should I do if I'm out of the Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) coverage area and need emergency services?

    If you have an emergency when you are not in our service area, you can obtain emergency services at the nearest emergency facility (doctor's office, clinic or hospital). Emergency services do not require a referral or an okay from your PCP doctor.

  • How do I obtain care after normal business hours?

    It is important you always carry your Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) ID card with you. If you think you have an emergency, call 911 or go to the nearest emergency room. If you need urgent care (when a condition, illness, or injury is not life threatening, but medical care is needed right away) call or go to your nearest urgent care center.

  • What if I also qualify for Medicare benefits, and I already have my Medi-Cal benefits with Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018)? Who would be primary? Can I combine them?

    If you are a Medi-Cal member and eligible for Medicare, it is important that you know that Medicare, not Medi-Cal, is your primary insurance. Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) also offers Medicare coverage; if you are interested in combining your benefits please call Member Services for more information on the additional benefits available.

  • What should I do if I receive a bill for covered services?

    You should not receive a bill for any covered services. If you do, please call Member Services at:

    1-800-605-2556
    8 a.m. to 6 p.m., Monday through Friday
    (TTY) 1-800-735-2929 – hours same as above
  • How can I be sure my medical information is protected?

    There are federal and state laws that protect the privacy of your medical records and personal health information. We protect your personal health information under these laws. Any personal health information that you give us when you enroll in this plan is protected. We will make sure that unauthorized people don't see or change your records. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services.

    1-800-605-2556
    8 a.m. to 6 p.m., Monday through Friday
    (TTY) 1-800-735-2929 – hours same as above
  • What benefits and services are not covered?

    Some services are not covered by Blue Shield of California Promise Medi-Cal Health Plan (Care1st Health Plan until 12/31/2018) but are still benefits available through Med-Cal or another State program. Please call Member Services if you have any questions.
    The following are non-covered services:

    • Acupuncture
    • Adult day health care
    • Alcohol and drug treatment services (outpatient)
    • Childhood lead poisoning
    • Chiropractic services
    • Mental Health Benefits
  • What can I do if I move out of your service area?

    If you move outside of Los Angeles County but still live in California, call your eligibility worker at DPSS right away toll free at 1-866-613-3777. Your eligibility worker can help you find out what Medi-Cal services are available in your new community.

  • How can a Member Self Referral for Case Management services?

    Case Management is a program for assisting members with complex care needs, often due to complications from chronic conditions such as diabetes, heart conditions, or a combination of such illnesses.

    These needs include helps with navigating the health care system, identifying and engaging community resources, benefit management, or transitions to other levels of care.

    Chronic Conditions that Qualify for Complex Case Management

    • Diabetes
    • Renal Failure
    • Hypertension
    • COPD, Pneumonia, Asthma, Respiratory Failure, Pulmonary HTN, Emphysema, Chronic Bronchi
    • CHF, Cardiomyopathy, CAD, Arrythmias,
    • SLE, Rheumatoid Arthritis
    • Diseases of Musculo Skeletal System: Multiple Sclerosis
    • Parkinson’s Disease, Alzheimers, Advanced Dementia
    • Cirrhosis of Liver / Chronic Liver Disease
    • Pressure Ulcers
    • HIV/AIDS
    • Metastatic Cancer
    • Severe, persistent mental illness
    • Spinal injuries

    For more information about case management, or to make a referral, call the Care1st UM Department at 1-800-605-2556 ext. 6090 and ask to speak with a Case Manager.